The surgical treatment of anterior shoulder instability.

Selective capsular repair for anterior instability allows the surgical technique to address the pathology encountered. Capsular tensioning may be performed on either the medial (glenoid) or lateral (humeral) side of the joint depending upon the presence of a Bankart lesion. An initial transverse capsular incision or an enlarged rotator interval defect allows visualization of the joint and flexibility in determining the site of the repair. The arm position is instrumental in determining the appropriate tension necessary to restore stability. Overtightening must be avoided to prevent loss of motion, secondary posterior instability, or glenohumeral arthritis. Examination of the joint following the repair should reveal the elimination of the pathologic anterior translation, reduction in the inferior translation, and the degree of external rotation desired to meet the specific goals of the patient.